| National Provider Identifier [NPI]: | 1417987421 |
| Last Name Of The Provider | FOTRE |
| First Name Of The Provider | TERRY |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 795 EL CAMINO REAL |
| Street Address 2 Of The Provider | |
| City Of The Provider | PALO ALTO |
| Zip Code Of The Provider | 943012302 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 1361 |
| Number Of Medicare Beneficiaries | 254 |
| Total Submitted Charge Amount | 112950 |
| Total Medicare Allowed Amount | 43069.82 |
| Total Medicare Payment Amount | 31174.91 |
| Total Medicare Standardized Payment Amount | 26109.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 21 |
| Number Of Drug Services | 928 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 3697 |
| Total Drug Medicare AllowedAmount | 1748.35 |
| Total Drug Medicare PaymentAmount | 1370.08 |
| Total Drug Medicare Standardized Payment Amount | 1370.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 433 |
| Number Of Medicare Beneficiaries With Medical Services | 254 |
| Total Medical Submitted Charge Amount | 109253 |
| Total Medical Medicare Allowed Amount | 41321.47 |
| Total Medical Medicare Payment Amount | 29804.83 |
| Total Medical Medicare Standardized Payment Amount | 24739.48 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 96 |
| Number Of Beneficiaries Age 75 to 84 | 70 |
| Number Of Beneficiaries Age Greater 84 | 68 |
| Number Of Female Beneficiaries | 150 |
| Number Of Male Beneficiaries | 104 |
| Number Of Non Hispanic White Beneficiaries | 212 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 234 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1045 |